Cardiac Effects of COVID-19 Infection, MIS-C, and the Vaccine in Infants and Children: What Is Known and Future Implications

Bryanna N. Schwartz; Ashraf S. Harahsheh; Anita Krishnan; Gerard R. Martin

doi:10.1055/s-0042-1757238

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2022; 39(S 01): S1-S6
DOI: 10.1055/s-0042-1757238

Review Article

Cardiac Effects of COVID-19 Infection, MIS-C, and the Vaccine in Infants and Children: What Is Known and Future Implications

Bryanna N. Schwartz

¹Division of Cardiology, Children's National Hospital, Washington, District of Columbia

²Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia

,

Ashraf S. Harahsheh

¹Division of Cardiology, Children's National Hospital, Washington, District of Columbia

²Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia

,

Anita Krishnan

¹Division of Cardiology, Children's National Hospital, Washington, District of Columbia

²Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia

,

Gerard R. Martin

¹Division of Cardiology, Children's National Hospital, Washington, District of Columbia

²Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia

› Institutsangaben

Abstract

The cardiac effects of novel coronavirus disease 2019 (COVID-19) infection on the pediatric heart has become an area of particular interest as elevated cardiac enzymes and abnormalities on echocardiogram and electrocardiogram were seen in a portion of children affected by the virus. In this article, we review the cardiac manifestations of acute COVID-19 infection, multisystem inflammatory syndrome in children, and postvaccine myocarditis. The limited research on the effects of COVID-19 on neonates and infants is also reported.

Key Points

Cardiac involvement from MIS-C is much higher than the risk of COVID-19 vaccine-induced myocarditis.
Neonates and infants have overall been less affected by COVID-19 than adults and older children.
At this point in time, there is limited research on the cardiac effects of COVID-19 in neonates.

Keywords

pediatric cardiology - COVID-19 - multisystem inflammatory syndrome in children - MIS-N - COVID-19 myocarditis

Volltext

Referenzen

References
1 Molloy EJ, Lavizzari A, Klingenberg C. et al; International Neonatal COVID-19 Consortium. Neonates in the COVID-19 pandemic. Pediatr Res 2021; 89 (05) 1038-1040
2 Harahsheh AS, Selekman RE, Simpson JN. et al. Children's hospital ambulatory response to the 2019 novel coronavirus disease (COVID-19) pandemic. J Ambul Care Manage 2021; 44 (03) 184-196
3 Hillis SD, Blenkinsop A, Villaveces A. et al. COVID-19–associated orphanhood and caregiver death in the United States. Pediatrics 2021; 148 (06) e2021053760
4 Loke YH, Berul CI, Harahsheh AS. Multisystem inflammatory syndrome in children: Is there a linkage to Kawasaki disease?. Trends Cardiovasc Med 2020; 30 (07) 389-396
5 Whittaker E, Bamford A, Kenny J. et al; PIMS-TS Study Group and EUCLIDS and PERFORM Consortia. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA 2020; 324 (03) 259-269
6 Feldstein LR, Rose EB, Horwitz SM. et al; Overcoming COVID-19 Investigators, CDC COVID-19 Response Team. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med 2020; 383 (04) 334-346
7 Harahsheh AS, Krishnan A, DeBiasi RL. et al. Cardiac echocardiogram findings of severe acute respiratory syndrome coronavirus-2-associated multi-system inflammatory syndrome in children. Cardiol Young 2022; 32 (05) 718-726
8 Fremed MA, Healy EW, Choi NH. et al. Elevated cardiac biomarkers and outcomes in children and adolescents with acute COVID-19. Cardiol Young 2022; 1-7
9 Dimopoulou D, Spyridis N, Dasoula F. et al. Pericarditis as the main clinical manifestation of COVID-19 in adolescents. Pediatr Infect Dis J 2021; 40 (05) e197-e199
10 Garau G, Joachim S, Duliere GL. et al. Sudden cardiogenic shock mimicking fulminant myocarditis in a surviving teenager affected by severe acute respiratory syndrome coronavirus 2 infection. ESC Heart Fail 2021; 8 (01) 766-773
11 Chiotos K, Hayes M, Kimberlin DW. et al. Multicenter interim guidance on use of antivirals for children with coronavirus disease 2019/severe acute respiratory syndrome coronavirus 2. J Pediatric Infect Dis Soc 2021; 10 (01) 34-48
12 COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. Accessed April 12, 2022 at: www.covid19treatmentguidelines.nih.gov/
13 Deville J, Song E, Ouellette C. COVID-19: Management in children. UpToDate. Accessed September 1, 2022 at: https://www.uptodate.com/contents/covid-19-management-in-children?search=pediatric%20treatment%20acute%20covid-19&source
14 Webster G, Patel AB, Carr MR. et al. Cardiovascular magnetic resonance imaging in children after recovery from symptomatic COVID-19 or MIS-C: a prospective study. J Cardiovasc Magn Reson 2021; 23 (01) 86
15 Daniels CJ, Rajpal S, Greenshields JT. et al; Big Ten COVID-19 Cardiac Registry Investigators. Prevalence of clinical and subclinical myocarditis in competitive athletes with recent SARS-CoV-2 infection: results from the big ten COVID-19 cardiac registry. JAMA Cardiol 2021; 6 (09) 1078-1087
16 Waltuch T, Gill P, Zinns LE. et al. Features of COVID-19 post-infectious cytokine release syndrome in children presenting to the emergency department. Am J Emerg Med 2020; 38 (10) 2246.e3-2246.e6
17 Stierman B, Abrams JY, Godfred-Cato SE. et al. Racial and ethnic disparities in multisystem inflammatory syndrome in children in the United States, March 2020 to February 2021. Pediatr Infect Dis J 2021; 40 (11) e400-e406
18 Payne AB, Gilani Z, Godfred-Cato S. et al; MIS-C Incidence Authorship Group. Incidence of multisystem inflammatory syndrome in children among US persons infected with SARS-CoV-2. JAMA Netw Open 2021; 4 (06) e2116420
19 Javalkar K, Robson VK, Gaffney L. et al. Socioeconomic and racial and/or ethnic disparities in multisystem inflammatory syndrome. Pediatrics 2021; 147 (05) e2020039933
20 Basu S, Kim EJ, Sharron MP. et al. Strain echocardiography and myocardial dysfunction in critically ill children with multisystem inflammatory syndrome unrecognized by conventional echocardiography: a retrospective cohort analysis. Pediatr Crit Care Med 2022; 23 (03) e145-e152
21 Hejazi OI, Loke YH, Harahsheh AS. Short-term cardiovascular complications of multi-system inflammatory syndrome in children (MIS-C) in adolescents and children. Curr Pediatr Rep 2021; 9 (04) 93-103
22 Matsubara D, Chang J, Kauffman HL. et al. Longitudinal assessment of cardiac outcomes of multisystem inflammatory syndrome in children associated with COVID-19 infections. J Am Heart Assoc 2022; 11 (03) e023251
23 Belay ED, Abrams J, Oster ME. et al. Trends in geographic and temporal distribution of US children with multisystem inflammatory syndrome during the COVID-19 pandemic. JAMA Pediatr 2021; 175 (08) 837-845
24 Yasuhara J, Watanabe K, Takagi H, Sumitomo N, Kuno T. COVID-19 and multisystem inflammatory syndrome in children: a systematic review and meta-analysis. Pediatr Pulmonol 2021; 56 (05) 837-848
25 DeBiasi RL, Harahsheh AS, Srinivasalu H. et al; Children's National Hospital MIS-C Taskforce. Multisystem inflammatory syndrome of children: subphenotypes, risk factors, biomarkers, cytokine profiles, and viral sequencing. J Pediatr 2021; 237: 125-135.e18
26 Son MBF, Friedman K. COVID-19: multisystem inflammatory syndrome in children (MIS-C) management and outcome. UpToDate. Accessed April 5, 2022 at: https://www.uptodate.com/contents/covid-19-multisystem-inflammatory-syndrome-in-children-mis-c-management-and-outcome#H999319060
27 Henderson LA, Canna SW, Friedman KG. et al. American College of Rheumatology clinical guidance for multisystem inflammatory syndrome in children associated with SARS-CoV-2 and hyperinflammation in pediatric COVID-19: version 2. Arthritis Rheumatol 2021; 73 (04) e13-e29
28 Bhuiyan MU, Stiboy E, Hassan MZ. et al. Epidemiology of COVID-19 infection in young children under five years: a systematic review and meta-analysis. Vaccine 2021; 39 (04) 667-677
29 Rad HS, Röhl J, Stylianou N. et al. The effects of COVID-19 on the placenta during pregnancy. Front Immunol 2021; 12: 743022
30 Barrero-Castillero A, Beam KS, Bernardini LB. et al; Harvard Neonatal-Perinatal Fellowship COVID-19 Working Group. COVID-19: neonatal-perinatal perspectives. J Perinatol 2021; 41 (05) 940-951
31 Carsetti R, Quintarelli C, Quinti I. et al. The immune system of children: the key to understanding SARS-CoV-2 susceptibility?. Lancet Child Adolesc Health 2020; 4 (06) 414-416
32 Lee PI, Hu YL, Chen PY, Huang YC, Hsueh PR. Are children less susceptible to COVID-19?. J Microbiol Immunol Infect 2020; 53 (03) 371-372
33 More K, Aiyer S, Goti A. et al. Multisystem inflammatory syndrome in neonates (MIS-N) associated with SARS-CoV2 infection: a case series. Eur J Pediatr 2022; 181 (05) 1883-1898
34 Diggikar S, Nanjegowda R, Kumar A, Kumar V, Kulkarni S, Venkatagiri P. Neonatal multisystem inflammatory syndrome secondary to SARS-CoV-2 infection. J Paediatr Child Health 2022; 58 (05) 900-902
35 Diaz GA, Parsons GT, Gering SK, Meier AR, Hutchinson IV, Robicsek A. Myocarditis and pericarditis after vaccination for COVID-19. JAMA 2021; 326 (12) 1210-1212
36 Witberg G, Barda N, Hoss S. et al. Myocarditis after Covid-19 vaccination in a large health care organization. N Engl J Med 2021; 385 (23) 2132-2139
37 Dionne A, Sperotto F, Chamberlain S. et al. Association of myocarditis with BNT162b2 messenger RNA COVID-19 vaccine in a case series of children. JAMA Cardiol 2021; 6 (12) 1446-1450
38 Li X, Lai FTT, Chua GT. et al. Myocarditis following COVID-19 BNT162b2 vaccination among adolescents in Hong Kong. JAMA Pediatr 2022; 176 (06) 612-614
39 Kohli U, Lodha R. Cardiac involvement in children with COVID-19. Indian Pediatr 2020; 57 (10) 936-939
40 Wallace M, Oliver S. COVID-19 mRNA vaccines in adolescents and young adults: benefit-risk discussion. Slide 28. Published June 23, 2021. Accessed July 7, 2021 at: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-06/05-COVID-Wallace-508.pdf
41 Walter EB, Talaat KR, Sabharwal C. et al; C4591007 Clinical Trial Group. Evaluation of the BNT162b2 Covid-19 vaccine in children 5 to 11 years of age. N Engl J Med 2022; 386 (01) 35-46
42 Jone PN, John A, Oster ME. et al; American Heart Association Leadership Committee and Congenital Cardiac Defects Committee of the Council on Lifelong Congenital Heart Disease and Heart Health in the Young; Council on Hypertension, and Council on Peripheral Vascular Disease. SARS-CoV-2 infection and associated cardiovascular manifestations and complications in children and young adults: a scientific statement from the American Heart Association. Circulation 2022; 145 (19) e1037-e1052
43 Olson SM, Newhams MM, Halasa NB. et al; Overcoming COVID-19 Investigators. Effectiveness of Pfizer-BioNTech mRNA vaccination against COVID-19 hospitalization among persons aged 12-18 years - United States, June-September 2021. MMWR Morb Mortal Wkly Rep 2021; 70 (42) 1483-1488
44 Gargano JW, Wallace M, Hadler SC. et al. Use of mRNA COVID-19 vaccine after reports of myocarditis among vaccine recipients: update from the Advisory Committee on Immunization Practices - United States, June 2021. MMWR Morb Mortal Wkly Rep 2021; 70 (27) 977-982